Health, Housing, and Service Supports for Three Groups of People Experiencing Chronic Homelessness. 3.2. Where Care is Delivered

02/24/2012

Care for people in all groups may occur in a variety of locations in relation to housing:

  • In the client’s home--case managers or teams visit clients in their own apartments, whether scattered throughout the community or in buildings dedicated to PSH or mixed-use buildings.

  • In the client’s building, but not in the client’s own unit--dedicated PSH and mixed-use buildings provide office/treatment/counseling space for case managers and teams, and sometimes also for primary care clinicians, psychiatric nurses, social workers, employment agency staff, benefits eligibility workers, and the like. The people providing these services may have their primary offices in the building or may be part of a mobile team that rotates among locations.

  • Outside the client’s building, but in the immediate neighborhood--a team may work out of a nearby storefront, or park mobile vans in the vicinity of one or several PSH buildings at predictable times, and clients visit them there.

  • In clinic settings--clients come to the clinic to get care or to see their case manager or treatment staff. Clinic settings may be close to PSH buildings or in neighborhoods where many clients live in scattered-site PSH. These settings may be devoted entirely to clinical functions or located jointly with more social activities such as a drop-in or resource center.

Clients often receive health and behavioral health care in more than one location--care delivered closer to where clients live is sometimes used to establish a relationship during which the provider urges clients to “come visit me” in a clinic setting. Some providers find that care delivered where clients live is very effective: clients get the care they need and not either the wrong care, too much care, or too little care. Further, they believe that clients like it. On the other hand, some providers fear that offering clinical care where people live moves too much in the direction of re-creating residential treatment institutions. The latter providers work with clients to teach them how to manage their own health care and their relationships with health care providers.

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